Which of the following statements about diffuse esophageal spasm is/are true?

C. Associated psychiatric disorders are common.

D. During manometric assessment, unless the patient is having pain there may be no detectable multiphasic, highamplitude, simultaneous esophageal contractions.

DISCUSSION: The chest pain of diffuse esophageal spasm is often indistinguishable from that of angina pectoris of cardiac origin. Many patients undergo cardiac catheterization to rule out coronary artery disease. Patients may experience slow emptying of the esophagus, but obstructive symptoms and regurgitation of food are unusual. Psychiatric disorders (depression, psychosomatic complaints, anxiety) have been documented in more than 80% of patients with esophageal contraction abnormalities. The classic manometric criteria of diffuse esophageal spasm are simultaneous, multiphasic, repetitive, high-amplitude contractions occurring after a swallow and spontaneously. These changes may not be detected if manometry is performed when the patient is having no pain. As the cause of esophageal spasm is unknown, treatment is far from ideal. Conservative management—avoidance of “trigger” foods and drinks, psychiatric counseling, treatment of reflux, esophageal dilatations, use of histamine H 2 blockers, anti-spasmodics, and smooth muscle relaxants—should always be attempted first. Esophagomyotomy provides no lasting relief of esophageal spasm for as many as 50% of patients and should be used only in a minority of these patients.